Doctors as managers: moving towards general management? The case of unitary management reform in Norwegian hospitals.
OBJECTIVE
The paper seeks to explore whether the development in department management in Norwegian hospitals after the unitary management reform in 2001 constitutes a development in the direction of general management.


METHODS
Interviews were conducted with ten managers from different levels in a large Norwegian university hospital in 2001-2002, as a unitary management model was implemented.


RESULTS
There is an emerging change of practice among the physician managers according to this study. The manager function is more explicit and takes a more general responsibility for the department and the professions. However, the managerial function is substantiated by conditions related to the professional field of knowledge, which gives legitimacy within a medical logic. Contact with the clinic is stressed as important, but it is possible to adjust both amount and content of a clinical engagement to the demands of the new manager position. This has both a symbolic and a practical significance, as it involves both legitimacy and identity issues.


CONCLUSIONS
The paper shows that the institutionalised medical understanding of management has a bearing on managerial reforms. Managerial changes need to relate to this if they are to have consequences for the managerial roles and structures on department level in hospitals.


CONCLUSIONS
The paper suggests that the future development of this role will depend on the way the collectivist and individualist aspects of responsibility are handled, as well as on the further development of managerial knowledge of physicians.
Mo
Tone Opdahl
TO
SINTEF Health Research, Trondheim, Norway. tone.opdahl.mo@sintef.no
D005260:Female; D006739:Hospital Administration; D006740:Hospital Administrators; D006748:Hospital Departments / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017146:Models, Organizational; D009664:Norway; D009936:Organizational Innovation; D008486:Physician Executives